In the summer of 2011, LGiU associates undertook the first large-scale study of HWBs.
People we spoke to were determined their board should not become a talking shop or hung up on process, and where advanced partnership arrangements such as integrated services were already in place, they were keen that these should be maintained and built upon.
The new Kings Fund survey – Health and Wellbeing Boards: system leaders or talking shops? reiterates these themes. Although it was carried out last year, issues raised at the National HWB Conference in April 2012 show that many are of ongoing concern, for example:
- should providers have a place on the HWB
- how will HWBs influence major reconfiguration when there are national directives (e.g. to CCGs) regarding strategic leadership
- how will boards work in a two-tier system
- should adult and children’s be commissioned separately or together – should commissioning be aligned
- how do we stop HWBs being pulled into issues of acute reconfiguration and going into ‘scrutiny’ mode?
An important issue which is not yet being addressed head-on is the relationship between the council and the HWB as a council committee. This is will be particularly important in relation to NHS provider reconfigurations which so often prove politically challenging. The Kings Fund describes the situation regarding contested reconfiguration as follows:
‘Even where there is a compelling case for change on the grounds of clinical safety or outcomes, the local authority will come under pressure to reflect local opinion and preserve valued services…In these circumstances the local health and wellbeing boards will be in the eye of the storm and the current wave of generalised goodwill on which they have been riding will quickly dissipate.’
The key words here are ‘a compelling case for change on the grounds of clinical safety or outcomes’. Although situations are rarely completely clear-cut and political pressures are very real, it is clearly important that HWBs will need to develop skills in assessing the evidence-base of a proposal and transmitting accurate messages to the public.